ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

Vancomycin inhibits bacterial cell wall synthesis by binding to the D-alanyl - D-alanine cell wall precursor and blocking peptidoglycan polymerization.

Vancomycin only covers Gram-positive bacteria, including Staphylococci (MRSA), Streptococci, Enterococci (not VRE) and C. difficile.

For systemic infections, the recommended IV dosing of vancomycin is 15-20 mg/kg Q8-12H, with the dose based on total body weight.

<p>Abdominal pain, nausea, phlebitis, myelosuppression, drug fever, severe skin reactions</p> Signup and view all the answers

<p>Renal function, trough serum concentration at steady state, WBC Goal trough: 15-20 mcg/mL</p> Signup and view all the answers

<p>Nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs and radiographic contrast dye), ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics)</p> Signup and view all the answers

<p>Vancomycin inhibits bacterial cell wall synthesis by binding to the D-alanyl - D-alanine cell wall precursor and blocking peptidoglycan polymerization. It covers Gram-positive bacteria, including Staphylococci (MRSA), Streptococci, Enterococci (not VRE) and C. difficile.</p> Signup and view all the answers

<p>For systemic infections (IV only), the dosing recommendation is IV: 15-20 mg/kg Q8-12H based on total body weight. For C. difficile infections (PO only), the recommendation is PO: 125-500 mg QID x 10 days.</p> Signup and view all the answers

<p>Vancomycin is associated with ototoxicity and nephrotoxicity. Caution should be exercised when using other nephrotoxic or ototoxic drugs or with prolonged high serum concentrations. Dose adjustment is required in renal impairment. The PO route is used only for C. difficile infections.</p> Signup and view all the answers

<p>Side effects of Vancomycin include abdominal pain, nausea (oral route), phlebitis (irritation to vein), myelosuppression (neutropenia/thrombocytopenia), drug fever, and severe skin reactions (SJS/TEN).</p> Signup and view all the answers

<p>Monitoring for Vancomycin therapy should include renal function assessment and trough serum concentration at steady state, generally 30 minutes before the 4th or 5th dose. The goal trough concentration is 15-20 mcg/mL for conditions such as pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia.</p> Signup and view all the answers

<p>Vancomycin can increase the risk of nephrotoxicity when used with other nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, and radiographic contrast dye). It can also elevate the risk of ototoxicity when used with other ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics).</p> Signup and view all the answers

<p>The potential infusion reactions include red man syndrome, which presents as maculopapular rash, hypotension, flushing, and chills from too rapid of an infusion rate. To prevent this, vancomycin should not be infused faster than 1 gram per hour.</p> Signup and view all the answers

<p>The side effects of vancomycin therapy may include abdominal pain, nausea (with oral route), phlebitis (irritation to vein), myelosuppression (neutropenia/thrombocytopenia), drug fever, and severe skin reactions (SJS/TEN).</p> Signup and view all the answers

<p>When using vancomycin, the risk of nephrotoxicity is increased when used with other nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, and radiographic contrast dye). Vancomycin can also increase the risk of ototoxicity when used with other ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics).</p> Signup and view all the answers

<p>Vancomycin inhibits bacterial cell wall synthesis by binding to the D-alanyl - D-alanine cell wall precursor and blocking peptidoglycan polymerization. It covers Gram-positive bacteria, including Staphylococci (MRSA), Streptococci, Enterococci (not VRE), and C. difficile.</p> Signup and view all the answers

<p>For systemic infections (IV only), the dosing is 15-20 mg/kg Q24H. For C. difficile infections (PO only), the dosing is 125-500 mg QID x 10 days (upper end used for severe, complicated disease). No dose adjustment is required in renal impairment.</p> Signup and view all the answers

<p>Vancomycin is associated with ototoxicity and nephrotoxicity. Caution should be exercised with the use of other nephrotoxic or ototoxic drugs or with prolonged high serum concentrations. Dose adjustment is required in renal impairment. The PO route is used only for C. difficile infections.</p> Signup and view all the answers

<p>Infusion reaction/red man syndrome from vancomycin can present with maculopapular rash, hypotension, flushing, and chills when the drug is infused too rapidly, typically at rates faster than 1 gram per hour. This can be prevented by infusing vancomycin at a rate not exceeding 1 gram per hour.</p> Signup and view all the answers

<p>Potential side effects of vancomycin include abdominal pain, nausea (with oral route), phlebitis (irritation to vein), myelosuppression (neutropenia/thrombocytopenia), drug fever, and severe skin reactions (SJS/TEN). Vancomycin therapy should be monitored for renal function and trough serum concentration at steady state, with a goal trough of 15-20 mcg/mL for specific infections.</p> Signup and view all the answers

<p>Vancomycin use should be carefully monitored for potential interactions with other nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, and radiographic contrast dye) as they can increase the risk of nephrotoxicity. Additionally, vancomycin can potentiate the risk of ototoxicity when used with other ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics).</p> Signup and view all the answers

<p>The potential side effects of vancomycin therapy include abdominal pain, nausea, phlebitis, myelosuppression, drug fever, and severe skin reactions such as SJS/TEN. The infusion reactions may include red man syndrome, characterized by maculopapular rash, hypotension, flushing, and chills, which can be prevented by not infusing vancomycin faster than 1 gram per hour.</p> Signup and view all the answers

<p>The recommended monitoring parameters for vancomycin therapy include monitoring renal function and trough serum concentration at steady state, generally 30 minutes before the 4th or 5th dose. The goal trough concentration is 15-20 mcg/mL for indications such as pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia.</p> Signup and view all the answers

<p>When using vancomycin, it is important to consider the risk of nephrotoxicity when co-administered with other nephrotoxic drugs such as aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, and radiographic contrast dye. Vancomycin can also increase the risk of ototoxicity when used with other ototoxic drugs like aminoglycosides, cisplatin, and loop diuretics.</p> Signup and view all the answers

<p>Telavancin (Vibativ) Injection: Approved for complicated skin and soft-tissue infections (SSTI) and hospital-acquired and ventilator-associated pneumonia. Oritavancin (Orbactiv) Injection: Approved for SSTI. Dalbavancin (Dalvance) Injection: Approved for SSTI.</p> Signup and view all the answers

<p>Fetal risk - obtain pregnancy test prior to starting therapy; nephrotoxicity; Increased mortality with pre-existing moderate-to-severe renal impairment (CrCI when compared to vancomycin in pneumonia trials.</p> Signup and view all the answers

<p>They inhibit bacterial cell wall synthesis by binding to the D-alanyl- D-alanine portion of the cell wall, blocking polymerization and cross-linking of peptidoglycan, and disrupting bacterial membrane potential and changing cell permeability.</p> Signup and view all the answers

<p>They have concentration-dependent antibacterial activity and have similar coverage to vancomycin, with the exception that they only come in IV form and cannot be used to treat C. difficile infections.</p> Signup and view all the answers

<p>Lipoglycopeptides inhibit bacterial cell wall synthesis by binding to the D-alanyl- D-alanine portion of the cell wall, blocking polymerization and cross-linking of peptidoglycan, and disrupting bacterial membrane potential and changing cell permeability due to the presence of a lipophilic side chain. This differs from vancomycin, which primarily inhibits cell wall synthesis by binding to the D-alanyl-D-alanine portion of the cell wall.</p> Signup and view all the answers

<p>Telavancin (Vibativ) Injection is approved for complicated skin and soft-tissue infections (SSTI) and hospital-acquired and ventilator-associated pneumonia. Oritavancin (Orbactiv) Injection is approved for SSTI. Dalbavancin (Dalvance) Injection is approved for SSTI.</p> Signup and view all the answers

<p>The boxed warnings for lipoglycopeptides include fetal risk (pregnancy test should be obtained prior to starting therapy), nephrotoxicity, and increased mortality with pre-existing moderate-to-severe renal impairment (CrCl) when compared to vancomycin in pneumonia trials.</p> Signup and view all the answers

<p>Lipoglycopeptides have concentration-dependent antibacterial activity and have similar coverage to vancomycin. However, they only come in IV form and cannot be used to treat C. difficile infections.</p> Signup and view all the answers

<p>Lipoglycopeptides inhibit bacterial cell wall synthesis by binding to the D-alanyl-D-alanine portion of the cell wall, blocking polymerization and cross-linking of peptidoglycan, and disrupting bacterial membrane potential and changing cell permeability due to the presence of a lipophilic side chain. This differs from vancomycin's mechanism of action which primarily involves binding to the D-alanyl-D-alanine portion of the cell wall and blocking peptidoglycan synthesis.</p> Signup and view all the answers

<p>The boxed warnings associated with lipoglycopeptides include fetal risk (pregnancy test should be obtained prior to starting therapy), nephrotoxicity, and increased mortality with pre-existing moderate-to-severe renal impairment when compared to vancomycin in pneumonia trials.</p> Signup and view all the answers

<p>The lipoglycopeptide drugs are Telavancin (Vibativ) Injection approved for complicated skin and soft-tissue infections (SSTI) and hospital-acquired and ventilator-associated pneumonia, Oritavancin (Orbactiv) Injection approved for SSTI, and Dalbavancin (Dalvance) Injection approved for SSTI.</p> Signup and view all the answers

<p>Lipoglycopeptides have concentration-dependent antibacterial activity and have similar coverage to vancomycin, except that they only come in IV form and cannot be used to treat C. difficile infections.</p> Signup and view all the answers

<p>Use caution when coadministered with drugs metabolized by CYP2C9 and CYP2C19, as oritavancin is a weak inhibitor of these enzymes.</p> Signup and view all the answers

<p>Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure, as it can further prolong the QT interval.</p> Signup and view all the answers

<p>Use caution with other medications known to prolong the QT interval, as telavancin can exacerbate this effect, as mentioned in the Arrhythmias chapter.</p> Signup and view all the answers

<p>Oritavancin is a weak inhibitor of CYP2C9 and CYP2C19, and a weak inducer of CYP3A4 and CYP2D6.</p> Signup and view all the answers

<p>Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure. Caution should be used with other medications known to prolong the QT interval.</p> Signup and view all the answers

<p>Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure. Oritavancin is a weak inhibitor of CYP2C9 and CYP2C19, and a weak inducer of CYP3A4 and CYP2D6. Use caution when coadministered with drugs metabolized by these enzymes (including warfarin).</p> Signup and view all the answers

<p>Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure. Caution should be exercised with other medications known to prolong the QT interval. Oritavancin is a weak inhibitor of CYP2C9 and CYP2C19, and a weak inducer of CYP3A4 and CYP2D6, therefore, caution is advised when coadministered with drugs metabolized by these enzymes, including warfarin.</p> Signup and view all the answers

<p>Oritavancin is a weak inhibitor of CYP2C9 and CYP2C19, and a weak inducer of CYP3A4 and CYP2D6. When coadministered with drugs metabolized by these enzymes, caution is advised due to potential interactions affecting the metabolism of these drugs.</p> Signup and view all the answers

<p>Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure. Additionally, caution is advised when using telavancin with other medications known to prolong the QT interval or with drugs metabolized by specific enzymes like CYP3A4, CYP2D6, CYP2C9, and CYP2C19.</p> Signup and view all the answers

<p>Daptomycin is a cyclic lipopeptide that binds to cell membrane components, causing rapid depolarization, inhibiting intracellular replication processes, including protein synthesis, and causing cell death. It has concentration-dependent antibacterial activity against most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (both species of VRE, E. faecium and E. faecalis).</p> Signup and view all the answers

<p>Daptomycin (Cubicin, Cubicin RF) is approved for complicated skin and soft-tissue infections (SSTI) and S.aureus (MRSA) bloodstream infections, including right-sided endocarditis. It should not be used to treat pneumonia as the drug is inactivated in the lungs by surfactant.</p> Signup and view all the answers

<p>Warnings associated with Daptomycin include myopathy, rhabdomyolysis, and the potential to falsely increase PT/INR. The side effects include an increase in creatine phosphokinase (CPK) levels, which should be monitored weekly (more frequently if on a statin or with renal impairment).</p> Signup and view all the answers

<p>Daptomycin can have additive risk of muscle toxicity when used in conjunction with statins. It is important to monitor CPK levels, especially if the patient is on a statin or has renal impairment.</p> Signup and view all the answers

<p>Daptomycin is a cyclic lipopeptide that binds to cell membrane components, causing rapid depolarization, inhibiting intracellular replication processes, including protein synthesis, and causing cell death. It has concentration-dependent antibacterial activity against most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (both species of VRE, E. faecium and E. faecalis).</p> Signup and view all the answers

<p>The warnings associated with Daptomycin include myopathy and rhabdomyolysis, and the potential to falsely increase PT/INR. The side effects include an increase in CPK levels.</p> Signup and view all the answers

<p>Daptomycin can have additive risk of muscle toxicity when used in conjunction with statins. Monitoring of CPK levels is recommended, especially if the patient is on a statin or has renal impairment.</p> Signup and view all the answers

<p>Daptomycin (Cubicin, Cubicin RF) is approved for complicated skin and soft-tissue infections (SSTI) and S.aureus (MRSA) bloodstream infections, including right-sided endocarditis. It is not recommended for the treatment of pneumonia, as the drug is inactivated in the lungs by surfactant.</p> Signup and view all the answers

<p>Daptomycin has concentration-dependent antibacterial activity against most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (both species of VRE, E. faecium and E. faecalis).</p> Signup and view all the answers

<p>Daptomycin warnings include myopathy and rhabdomyolysis, and it can falsely increase PT/INR. The side effect that should be monitored is the increase in CPK levels, with monitoring recommended weekly or more frequently if on a statin or with renal impairment.</p> Signup and view all the answers

<p>Cubicin is compatible with normal saline (NS) and lactated Ringer's (LR) without dextrose, while Cubicin RF is compatible with NS without dextrose, but must use only sterile or bacteriostatic water for injection to reconstitute the lyophilized powder. Daptomycin can have an additive risk of muscle toxicity when used with statins.</p> Signup and view all the answers

<p>Daptomycin can have an additive risk of muscle toxicity when used with statins. It should not be used to treat pneumonia because the drug is inactivated in the lungs by surfactant.</p> Signup and view all the answers

<p>They bind to the SOS subunit of the bacterial ribosome, inhibiting translation and protein synthesis.</p> Signup and view all the answers

<p>They have coverage similar to vancomycin, but also cover VRE (E. faecium and E. faecalis).</p> Signup and view all the answers

<p>The recommended dose for linezolid is 600 mg Q12H, and no dose adjustment is required in renal impairment. The IV:PO ratio is 1:1.</p> Signup and view all the answers

<p>Do not use with or within 2 weeks of MAO inhibitors. Warnings include duration-related myelosuppression, peripheral and optic neuropathy, serotonin syndrome, hypoglycemia, seizures, lactic acidosis, and caution with insulin or other hypoglycemic drugs.</p> Signup and view all the answers

<p>They cover VRE (E. faecium and E. faecalis) as well as bacteria similar to vancomycin.</p> Signup and view all the answers

<p>Do not use with or within 2 weeks of MAO inhibitors.</p> Signup and view all the answers

<p>Warnings include duration-related myelosuppression, peripheral and optic neuropathy when used for more than 28 days, serotonin syndrome, hypoglycemia, seizures, and lactic acidosis.</p> Signup and view all the answers

<p>They are reversible monoamine oxidase inhibitors, so it is important to avoid tyramine-containing foods and serotonergic drugs. Additionally, caution is advised when used with insulin or other hypoglycemic drugs.</p> Signup and view all the answers

<p>They bind to the SOS subunit of the bacterial ribosome, inhibiting translation and protein synthesis.</p> Signup and view all the answers

<p>Contraindications include not using with or within 2 weeks of MAO inhibitors. Warnings include duration-related myelosuppression, peripheral and optic neuropathy when used &gt; 28 days, serotonin syndrome, hypoglycemia, seizures, lactic acidosis, and caution with insulin or other hypoglycemic drugs.</p> Signup and view all the answers

<p>Reduced platelets, reduced Hgb, reduced WBC, headache, nausea, diarrhea, and increased LFTs.</p> Signup and view all the answers

<p>They are reversible monoamine oxidase inhibitors and should avoid tyramine-containing foods and serotonergic drugs. Linezolid can exacerbate hypoglycemic episodes, so caution should be used in patients receiving insulin or oral hypoglycemic drugs.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is a streptogramin that binds to the 50S ribosomal subunit, inhibiting protein synthesis.</p> Signup and view all the answers

<p>The safety considerations and side effects of Quinupristin/Dalfopristin use include arthralgias/myalgias, infusion reactions, phlebitis, hyperbilirubinemia, CPK elevations, GI upset, and increased LFTs.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin should be diluted in D5W only and administered via a central line, such as a peripherally inserted central catheter (PICC), to avoid phlebitis.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is a weak CYP3A4 inhibitor and can affect the levels of CCBs, cyclosporine, dofetilide, and other drugs.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is a streptogramin that binds to the 50S ribosomal subunit, inhibiting protein synthesis. It covers most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococcus faecium (VRE, but not E. faecalis).</p> Signup and view all the answers

<p>The side effects and safety concerns associated with Quinupristin/Dalfopristin include arthralgias/myalgias, infusion reactions, phlebitis, hyperbilirubinemia, CPK elevations, gastrointestinal upset, and increases in LFTs. It is also not well-tolerated and is typically limited to vancomycin-resistant Enterococcus faecium infections.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin should be diluted in D5W only and administered via a central line to avoid phlebitis. It is a weak CYP3A4 inhibitor and can affect the levels of CCBs, cyclosporine, dofetilide, and other drugs.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is approved for complicated skin and soft-tissue infections, particularly in cases of vancomycin-resistant Enterococcus faecium infections.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is a streptogramin that binds to the 50S ribosomal subunit inhibiting protein synthesis. It covers most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococcus faecium (VRE, but not E. faecalis).</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin has safety considerations such as arthralgias/myalgias, infusion reactions, phlebitis, hyperbilirubinemia, CPK elevations, gastrointestinal upset, and increased liver function tests. It should be diluted in D5W only and administered via a central line to avoid phlebitis.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is a weak CYP3A4 inhibitor and can affect the levels of drugs such as calcium channel blockers, cyclosporine, and dofetilide.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is approved for complicated skin and soft-tissue infections, with limited use for vancomycin-resistant Enterococcus faecium infections.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is a streptogramin that binds to the 50S ribosomal subunit, inhibiting protein synthesis. It covers most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococcus faecium (VRE, but not E. faecalis).</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is associated with side effects such as arthralgias/myalgias, infusion reactions, phlebitis, hyperbilirubinemia, CPK elevations, GI upset, and increased LFTs. It should be diluted in D5W only and administered via a central line to avoid phlebitis.</p> Signup and view all the answers

<p>Quinupristin/Dalfopristin is a weak CYP3A4 inhibitor and can affect the levels of drugs such as calcium channel blockers, cyclosporine, dofetilide, and others.</p> Signup and view all the answers

<p>The use of Quinupristin/Dalfopristin is typically limited to vancomycin-resistant Enterococcus faecium infections.</p> Signup and view all the answers

<p>Tigecycline is a glycylcycline that binds to the 30S ribosomal subunit, inhibiting protein synthesis. It has a broad-spectrum of activity against Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (VRE), Gram-negative bacteria, anaerobes, and atypical organisms. It has no activity against the '3 P's': Pseudomonas, Proteus, Providencia species.</p> Signup and view all the answers

<p>Tigecycline has a boxed warning for increased risk of death and should only be used when alternative treatments are not suitable. It is associated with hepatotoxicity, pancreatitis, photosensitivity, lower cure rates in ventilator-associated pneumonia, and teeth discoloration in children under 8 years old. Common side effects include nausea, vomiting, diarrhea, headache, dizziness, elevated liver function tests, and rash/severe skin reactions.</p> Signup and view all the answers

<p>Tigecycline is not recommended for bloodstream infections as it does not achieve adequate concentrations in the blood. Reconstituted solution should be yellow-orange, and if not, it should be discarded. It should be used with caution in patients taking warfarin, as it can affect the International Normalized Ratio (INR).</p> Signup and view all the answers

<p>Tigecycline is approved for complicated skin and soft-tissue infections, intra-abdominal infections, and community-acquired pneumonia, with limited use due to safety concerns and boxed warning.</p> Signup and view all the answers

<p>Tigecycline binds to the 30S ribosomal subunit inhibiting protein synthesis and has a broad-spectrum of activity against Gram-positive bacteria including MRSA and VRE, Gram-negative bacteria, anaerobes, and atypical organisms.</p> Signup and view all the answers

<p>The boxed warning for Tigecycline includes an increased risk of death and should only be used when alternative treatments are not suitable. Potential side effects include hepatotoxicity, pancreatitis, photosensitivity, teeth discoloration in children under 8 years old, lower cure rates in ventilator-associated pneumonia, nausea, vomiting, diarrhea, headache, dizziness, elevated liver function tests, and rash/severe skin reactions (SJS).</p> Signup and view all the answers

<p>Tigecycline is approved for complicated skin and soft-tissue infections, intra-abdominal infections, and community-acquired pneumonia, with the limitation of not being suitable for bloodstream infections due to inadequate concentrations in the blood. Tigecycline can increase the INR in patients taking warfarin.</p> Signup and view all the answers

<p>The reconstituted solution of Tigecycline should be yellow-orange, and it should be discarded if not this color. Tigecycline does not achieve adequate concentrations in the blood since it is lipophilic, leading to quick distribution out of the blood into tissues.</p> Signup and view all the answers

<p>Tigecycline is a glycylcycline that binds to the 30S ribosomal subunit, inhibiting protein synthesis. It has a broad-spectrum of activity against Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (VRE), Gram-negative bacteria, anaerobes, and atypical organisms. However, it has no activity against the '3 P's': Pseudomonas, Proteus, Providencia species.</p> Signup and view all the answers

<p>Boxed Warning: Increased risk of death, use only when alternative treatments are not suitable. Warnings: Hepatotoxicity, pancreatitis, photosensitivity, teeth discoloration in children &lt; 8 years old (avoid use), lower cure rates in ventilator-associated pneumonia. Side Effects: N/V/D, headache, dizziness, elevated liver function tests, rash/severe skin reactions (SJS).</p> Signup and view all the answers

<p>Tigecycline is approved for complicated skin and soft-tissue infections, intra-abdominal infections, and community-acquired pneumonia. However, it should not be used for bloodstream infections as it does not achieve adequate concentrations in the blood due to its lipophilic nature.</p> Signup and view all the answers

<p>Tigecycline can affect the INR in patients taking warfarin. Additionally, the reconstituted solution should be yellow-orange; it should be discarded if not this color. Furthermore, Tigecycline should not be used in children below 8 years of age to avoid teeth discoloration.</p> Signup and view all the answers